de França Gustavo Campos, Barreto Henrique Carneiro de Barros, Paranhos Thiago, Nunes Julio Cesar, de Oliveira-Souza Ricardo
The D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil.
Front Neurol. 2022 Jan 18;12:798264. doi: 10.3389/fneur.2021.798264. eCollection 2021.
Catatonia is a psychomotor syndrome common to several medical and neuropsychiatric disorders. Here, we report on the case of a 95-year-old woman who underwent a radical change in personality characterized by sexual disinhibition, and physical and verbal aggressiveness. Over several months, she developed verbal stereotypies, gait deterioration, and double incontinence. She eventually developed mutism and an active opposition to all attempts to be fed or cared for. Benzodiazepines, olanzapine and electroconvulsive therapy were of no benefit. Magnetic resonance imaging revealed asymmetric (more severe on the right) frontotemporal, parietal, and upper brainstem atrophy. She died from sepsis without recovering from stupor seven years after the onset of symptoms. We believe that the initial behavioral disinhibition was related to the frontotemporal injury, whereas catatonic stupor reflected the progression of the degenerative process to the parietal cortices. Our case adds to the small number of cases of catatonia as a symptom of degenerative dementia. It also supports the idea that damage to the parietal cortex gives rise to pathological avoidance of which catatonic stupor represents an extreme form.
紧张症是一种常见于多种医学和神经精神疾病的精神运动综合征。在此，我们报告一例95岁女性病例，其性格发生了根本性变化，表现为性抑制解除、身体和言语攻击性。在几个月的时间里，她出现了言语刻板行为、步态恶化和大小便失禁。最终，她发展为缄默症，并积极抗拒所有喂食或护理尝试。苯二氮䓬类药物、奥氮平和电休克治疗均无效。磁共振成像显示不对称（右侧更严重）的额颞叶、顶叶和上脑干萎缩。症状出现七年后，她死于败血症，昏迷状态未恢复。我们认为最初的行为抑制与额颞叶损伤有关，而紧张性木僵反映了退行性过程向顶叶皮质的进展。我们的病例增加了作为退行性痴呆症状的紧张症的少数病例。它还支持这样一种观点，即顶叶皮质损伤会导致病理性回避，而紧张性木僵是其极端形式。
